
<div class="wrap_all_form wrap_addlist wrap_addlist_top">  
    <div class="col-md-6 Left_add"> 
        <div class="required w_sl_category">
            <label for="ListingCategories">Categories</label>
            <select id="ListingCategories" class="select sl_category">
                <option value="">-Select-</option>
                <option value="5">Arts &amp; Entertainment</option>
                <option value="3">Beauty &amp; Spas</option>
                <option value="4">Hotels &amp; Travel</option>
                <option value="1" selected="selected">Restaurants</option>
                <option value="6">Restaurants &gt; American</option>
                <option value="7">Restaurants &gt; Asian Fusion</option>
                <option value="8">Restaurants &gt; Chinese</option>
                <option value="9">Restaurants &gt; French</option>
                <option value="10">Restaurants &gt; Indian</option>
                <option value="11">Restaurants &gt; Italian</option>
                <option value="12">Restaurants &gt; Mexican</option>
                <option value="2">Shopping</option>
            </select>
        </div>  <!--/.w_sl_category--> 

        <div class="plan_info"> 
            <input type="radio" class="plan_select" name="" value="1" id="PlanInfo1" checked="checked">
            <label for="PlanInfo1">Bronze Plan<span class="clear"></span> - <span class="price_plan">$0</span></label>
            <div class="plan_description">
                <p>Here’s what comes with your Free Listing:</p>
                <ul>
                    <li>Your business details on our website</li>
                    <li>Add a description and an image to help customers find you</li>
                    <li>Upload 1 image</li>
                </ul>
            </div>
        </div><!--plan_info-->
        <div class="plan_info">
            <input type="radio" class="plan_select" name="" value="2" id="PlanInfo2">
            <label for="PlanInfo2">Silver Plan<span class="clear"></span> - <span class="price_plan">$25 per Month</span>   </label>
            <div class="plan_description">
                <p>Here’s what comes with your Silver Plan:</p>
                <ul>
                    <li>The ability to upload 5 images</li>
                    <li>Promote 2 deals</li>
                    <li>Promote 2 Events</li>
                </ul>
            </div>
        </div><!--plan_info-->
        <div class="plan_info"> 
            <input type="radio" class="plan_select" name="" value="4" id="PlanInfo4">
            <label for="PlanInfo4">Gold<span class="clear"></span> - <span class="price_plan">$50 per Month</span>  </label>
            <div class="plan_description">
                <p>Here’s what comes with your Gold Plan:</p>
                <ul>
                    <li>Great exposure for your business as it will be displayed as featured listing it's category</li>
                    <li>The ability to upload 10 images</li>
                    <li>Upload&nbsp; one video for your business</li>
                    <li>Promote 3 deals</li>
                    <li>Promote 3 events</li>
                </ul>
            </div>
        </div><!--plan_info-->

        <div class="input text required">
            <label for="ListingTitle">Title</label>
            <input name="" type="text" class="text" value="" id="ListingTitle">
        </div>
        <div class="input textarea">
            <label for="ListingDescription">Description</label>
            <textarea name="" class="textarea" id="ListingDescription"></textarea>
        </div>

    </div><!--Left_add-->

    <div class="col-md-6 right_add"> 
        <div class="fieldset Contact Info" id="fieldset_input_1">
            <fieldset> 
                <div class="custom_field" id="custom_field_1">  
                    <div class="input text required">
                        <label for="ListingAddress">Address</label>
                        <input name="" type="text" class="text" value="" id="ListingAddress">
                    </div> 
                </div><!--custom_field_1-->
                <div class="custom_field" id="custom_field_2">  
                    <div class="input text required">
                        <label for="ListingCity">City</label>
                        <input name="" type="text" class="text" value="" id="ListingCity">
                    </div> 
                </div><!--custom_field_2-->
                <div class="custom_field  col-md-4 custom_state" id="custom_field_3"> 
                    <div class="input select">
                        <label for="ListingState">State</label>
                        <select name="" class="select" id="ListingState">
                            <option value="">-Select-</option>
                            <option value="1">Alabama</option>
                            <option value="2">Alaska</option>
                            <option value="3">Arizona</option>
                            <option value="4">Arkansas</option>
                            <option value="5">California</option>
                            <option value="6">Colorado</option>
                            <option value="7">Connecticut</option>
                            <option value="8">Delaware</option>
                            <option value="9">Florida</option>
                            <option value="10">Georgia</option>
                            <option value="11">Hawaii</option>
                            <option value="12">Idaho</option>
                            <option value="13">Illinois</option>
                            <option value="14">Indiana</option>
                            <option value="15">Iowa</option>
                            <option value="16">Kansas</option>
                            <option value="17">Kentucky</option>
                            <option value="18">Louisiana</option>
                            <option value="19">Maine</option>
                            <option value="20">Maryland</option>
                            <option value="21">Massachusetts</option>
                            <option value="22">Michigan</option>
                            <option value="23">Minnesota</option>
                            <option value="24">Mississippi</option>
                            <option value="25">Missouri</option>
                            <option value="26">Montana</option>
                            <option value="27">Nebraska</option>
                            <option value="28">Nevada</option>
                            <option value="29"> New Hampshire</option>
                            <option value="30"> New Jersey</option>
                            <option value="31"> New Mexico</option>
                            <option value="32"> New York</option>
                            <option value="33"> North Carolina</option>
                            <option value="34"> North Dakota</option>
                            <option value="35">Ohio</option>
                            <option value="36">Oklahoma</option>
                            <option value="37">Oregon</option>
                            <option value="38">Pennsylvania</option>
                            <option value="39"> Rhode Island</option>
                            <option value="40"> South Carolina</option>
                            <option value="41"> South Dakota</option>
                            <option value="42">Tennessee</option>
                            <option value="43">Texas</option>
                            <option value="44">Utah</option>
                            <option value="45">Vermont</option>
                            <option value="46">Virginia</option>
                            <option value="47">Washington</option>
                            <option value="48"> West Virginia</option>
                            <option value="49">Wisconsin</option>
                            <option value="50"> Wyoming</option>
                        </select>
                    </div>                                
                </div><!--custom_field_3-->
                <div class="custom_field col-md-8 custom_zipcode" id="custom_field_4">  
                    <div class="input text required">
                        <label for="ListingZipcode">Zipcode</label>
                        <input name="" type="text" class="text" value="" id="ListingZipcode">
                    </div>                               
                </div><!--custom_field_4-->
                <div class="clear"></div>
                 <div class="custom_field custom_field_map">   
                    <div id="add_form_mapWrapper" style="width: 100%"> <img src="images/map_demo_01.jpg"></div>                                
                </div><!--custom_field_map-->

                <div class="custom_field" id="custom_field_5">  
                    <div class="input text">
                        <label for="ListingPhone"> Phone Number </label>
                        <input name="" type="text"  class="text" value="" id="ListingPhone">
                    </div> 
                </div><!--custom_field_5-->
                <div class="custom_field" id="custom_field_6">  
                    <div class="input text">
                        <label for="ListingWebsite">Website Address </label>
                        <input name="" type="text"  class="text url" value="" id="ListingWebsite">
                    </div>
                </div><!--custom_field_6-->
            </fieldset>  
        </div><!--/.Contact Info -->   

        <div class="input text">
            <label for="TagTag">Tags</label>
            <input name="" class="text" type="text" value="" id="TagTag">
        </div> 
        <div class="w_fiels_img"> 
            <div class="fieldWrap">
                <div class="horizontalInput-1 input text">
                    <label for="Listingasset_inputs0Name">Upload images</label>
                    <input type="file" name="" value="" class="file" id="Listingasset_inputs0Name">
                </div> 
            </div> 
            <a class="addAnotherField" href="#">Add more Images</a>
            <script type="text/javascript">
                $(document).ready(function(){ 
                    $(".addAnotherField").click(function () {
                      $(".fieldWrap").append('<input type="file" class="file">'); 
                    }); 
                });                            
            </script>              
        </div><!--w_fiels_img-->
        <div class="upload_filesize_limit_msg">The total size of all the files uploaded should be less than 16M </div>  

    </div><!-- /.right_add -->   
</div><!--/.wrap_addlist wrap_addlist_top-->  


<div class="wrap_all_form wrap_addlist wrap_addlist_bottom">  
    <div class="col-md-6 Left_add">  

        <div class="input checkbox add_review_link"> 
            <input type="checkbox" name="" class="checkbox" value="1" checked="checked" id="ListingAddReview">
            <label for="ListingAddReview">Write a review </label>
        </div><!--add_review_link-->
        <div id="review_form_fields_div" style="display: block;">
            <div>
                <fieldset>
                    <legend>Review</legend>
                    <div class="input text required">
                        <label for="ReviewTitle">Title</label>
                        <input name="]" type="text" validate="" class="text" value="" id="ReviewTitle">
                    </div>
                    <div class="input text required">
                        <label for="ReviewBody">Review</label>
                        <textarea name="" class="text textarea" id="ReviewBody"></textarea>
                    </div>           
                </fieldset>
            </div>  
        </div><!--review_form_fields_div-->
    </div><!--Left_add-->
    <div class="col-md-6 right_add"> 
        <div class="input select star" id="ReviewRateablefieldRate5">
            <label for="ReviewRateablefieldRate5">Rating</label>
            <div class="input select" id="ReviewRateablefieldRate5_wrapper">
                <div class="ui-stars-star">
                    <a title="">1</a>
                </div>
                <div class="ui-stars-star">
                    <a title="">2</a>
                </div>
                <div class="ui-stars-star">
                    <a title="">3</a>
                </div>
                <div class="ui-stars-star">
                    <a title="">4</a>
                </div>
                <div class="ui-stars-star">
                    <a title="">5</a>
                </div>
                <input type="hidden" name="" value="0" disabled="disabled">
            </div>
        </div>  <!--input select star-->  
    </div><!-- /.right_add -->   
</div><!--/.wrap_addlist /.wrap_addlist_bottom-->

<div class="submit"><input class="bt_submit" type="submit" value="Save"> </div>

 
